Vermont Department of Health Maternal and Child Health Division Children with Special Health Needs CoP Call October 2, 2013
New Definition for CSHN Eligibility Effective January 1, 2013 “CSHN serves those Vermont children and youth aged birth to 21, who have a chronic physical or developmental condition and who also require health and related services of a type or amount beyond that required by children generally.”
Infrastructure building Re-envisioning CSHN: Moving down the MCHB pyramid – a sustainability model Direct care services Enabling Population-based Infrastructure building child development clinic craniofacial team nutrition network Physiatry care coordination resource & referral respite financial technical assistance supplemental financial assistance (POLR) Vermont Family Network family support programming pediatric palliative care children’s personal care hi-tech nursing newborn screening system-wide educational materials on CSHN: transition, immunizations, environmental health community-based integration liaison to specialty care birth information network medical home capacity performance-based contracting CSHN specialty care certification children’s health and support services autism SIG university autism center pilot Medicaid advisory panel systems integration w/ other state services (CIS & Blueprint) IT integration
Children with Special Health Needs-Overview Child Development Clinic Care coordination Medical Home pilot Pediatric Hi-Tech Personal Care (ADL Assistance) Children’s Palliative Care Cleft Palate Clinic Rehabilitation Clinic Respite Financial Technical Assistance Community Nutrition Birth to age 21
Care Coordination: Integrating with a Statewide System of Care Care Coordinators: SWs & RNs Support and resource to families with CYSHN Member of regional CIS team Connected to (co-located in) PCP offices Liaison to health system Specialty Clinic teams Member of CSHN-hosted CDC team Liaison to Blueprint Medical Home initiative Co-located in Health Dept District offices Children’s Integrated Services (CIS) is a statewide resource for pregnant or postpartum women and families with children from birth to age six and Includes: Early Intervention, Nursing & Family Support, and Children’s Mental Health The Vermont Blueprint for Health (Medical Home initiative) is a vision, a plan, and a statewide partnership to improve health and the health care system for Vermonters. The goals are: 1) To implement a statewide system of care that enables Vermonters with, and at risk of, chronic disease to lead healthier lives; 2) To develop a system of care that is financially sustainable; and 3) To forge a public-private partnership to develop and sustain the new system of care.
Pediatric Collaborations in Chittenden County
Pediatric Hi-Tech Nursing Previously overseen by the Department of Aging and Independent Living (DAIL) Integrated into CSHN in January 2012, recognizing that most children were also enrolled with CSHN Public-private partnership providing skilled nursing, durable medical equipment, and care coordination
Children’s Personal Care Services (CPCS) Previously overseen by the Department of Aging and Independent Living (DAIL) Provides direct assistance with Activities of Daily Living to Medicaid eligible children, under the age of 21 Serves approximately 2,000 children, statewide Survey of participants found that 50% were also enrolled with CSHN Integrated into CSHN in January, 2012
Pediatric Palliative Care Program Part of the Chronic Care Initiative (DVHA) Close partnership with CSHN Nursing and Social Work Program eligibility: Under age 21 Medicaid eligible Diagnosed with life-limiting illness and not expected to live into adulthood Services include: Care coordination Family training Expressive therapy Skilled in-home respite Grief/bereavement counseling
Contact us: Steve Brooks – 802-865-1312 Carol Hassler – 802-865-1324 Steve.a.brooks@state.vt.us Carol Hassler – 802-865-1324 Carol.hassler@state.vt.us Janet Kilburn – 802-865-1323 Janet.kilburn@state.vt.us CSHN – P.O. Box 70, Burlington, VT 05402